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Although it is generally expected that inbreeding would lower fitness, few studies have directly quantified the effects of inbreeding in wild mammals. We investigated the effects of inbreeding using long-term data from bighorn sheep on Ram Mountain, Alberta, Canada, over 20 years. This population underwent a drastic decline from 1992 to 2002 and has since failed to recover. We used a pedigree to calculate inbreeding coefficients and examined their impact on lamb growth, birth date and survival. Inbreeding had a substantial effect on female survival: for a given mass in September, the probability of overwinter survival for inbred female lambs was about 40% lower than that of noninbred ones. Contrary to our expectations, inbred female lambs were born earlier than noninbred ones. Earlier birth led to inbred female lambs being heavier by mid-September than noninbred ones. There was a nonsignificant trend for inbred female yearlings to weigh more than noninbred ones. A stronger mass-dependent viability selection for inbred compared to noninbred female lambs may explain why surviving inbred females were heavier than noninbred ones. Survival of male lambs was not affected by inbreeding. Sex-differential effects of inbreeding may be a general pattern in sexually dimorphic mammals, because of sex-biased maternal care or sexual differences in early development strategies.

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BACKGROUND: The objective was to compare the changes in pathologic and clinical data over time for African-American (AA) and white men with prostate carcinoma undergoing radical prostatectomy in an attempt to determine the early impact of prostate specific antigen (PSA). METHODS: Data from 195 AA and 587 white men who underwent radical prostatectomy from 1988 to 1999 in an equal access, tertiary, military medical facility were collected. Statistical analysis was used to determine the significance of the changes in the rates of extracapsular extension (ECE), positive margins, pretreatment PSA levels, and age at the time of surgery for each race over time. RESULTS: Comparing 1988-99 results, the authors found that the percentage of AA men with ECE decreased from 100% to 34.8% (P = 0.007), and for white men from 56.9% to 43.2% (P = 0.269). The percentage of AA men with positive margins decreased from 100% to 26.1% (P < 0.0001), and for white men from 41.2% to 27.0% (P = 0.021). Mean age at surgery decreased from 66.6 to 59.9 years for AA men (P < 0.001) and from 65.9 to 61.1 years for white men (P < 0.001). Also, PSA levels decreased from 10.1 to 6.6 ng/dL for white men (P < 0.001) and from 16.5 to 6.5 ng/dL for AA men (P < 0.001). CONCLUSIONS: The authors believe that the decrease in ECE and positive margins in AA men is primarily because of PSA testing, coupled with improved public awareness and equal access to care. It appears reasonable to recommend PSA testing in AA men, who have historically experienced poor outcomes from prostate carcinoma.

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An 8-year-old girl presented with frequent, nonfebrile, urinary tract infections and a lifelong history of severe constipation. Ultrasound revealed bilateral duplicated renal systems, severe right upper pole hydronephrosis, and moderate left lower pole hydronephrosis. Computerized tomographic scan revealed a large, fecal-impacted colon. Diuretic renogram showed high-grade obstruction (T1/2 >30 minutes) of the right upper pole and left lower pole moieties. After administering an aggressive bowel preparation, a repeat diuretic renogram was performed, which revealed resolution of the left lower pole obstruction. Constipation has long been established as a contributing factor to urinary tract infections in children. However, fecal impaction causing ureteral obstruction in a child has not been reported. We report the case of an 8-year-old girl who had left lower pole ureteral obstruction secondary to fecal impaction.

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PURPOSE: A case of an adult patient with the anorectal malformation of a rectovestibular fistula successfully repaired by performing a posterior sagittal anorectoplasty is reported. This case should increase the awareness of both primary and secondary anorectal malformations in the adult patient. METHODS: Management and outcome of an adult patient who presented with a rectovaginal fistula and underwent primary operative correction of her anorectal malformation using posterior sagittal anorectoplasty is reviewed. RESULTS: Total continence was achieved in an adult patient undergoing primary repair of a rectovaginal fistula using posterior sagittal anorectoplasty. CONCLUSION: Posterior sagittal anorectoplasty can be successfully performed in the adult patient for a primary repair of anorectal malformations. This operation should be considered in patients who have undergone another prior operative procedure with less than optimum function and now desire a secondary corrective procedure.

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The authors describe a noninvasive technique for the management of giant omphaloceles. Two patients with giant omphaloceles were managed with external compression. Dry sterile dressings were used, buttressed by an Ace bandage in the first case and by a handcrafted Velcro abdominal binder in the second. The binder was tightened every 2 or 3 days. Renal, cardiovascular, respiratory, and gastrointestinal parameters were measured regularly to determine whether the binder was too tight. The first patient had only occasional emesis, and the defect was repaired after 40 days of compression. The second patient experienced intermittent hypertension, occasional emesis, and mild oxygen desaturation, which resolved when the binder was loosened slightly. The fascia muscle and skin were closed after 30 days of external compression. Both patients are currently living at home and doing well. This form of external compression is an effective, inexpensive, and low-risk method for the gradual reduction of giant omphaloceles, and should be considered for patients born with this problem.

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